The Foot Skin Microbiome in Diabetes Mellitus: Transitional Dysbiosis, Ulceration, and Precision Microbiome-Based Therapeutics: A Narrative Review
5 affiliations
- 1Department of Nursing, University of Valencia, 46010 Valencia, Spain
- 2Research Group on Prevention and Treatment of Diabetic Foot Syndrome, University of Valencia, 46010 Valencia, Spain
- 3Department of Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
- 4Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- 5Department of Biomedical Sciences, Faculty of Health Sciences, European University of Valencia, Paseo de La Alameda, 7, 46010 Valencia, Spain
Abstract
Diabetic foot syndrome (DFS) is a severe complication affecting millions of people worldwide, yet its clinical management remains predominantly reactive, focusing on established ulcers rather than early preventive measures. Although the role of the cutaneous microbiome in chronic wounds is recognized, longitudinal ecological shifts in the skin of the foot throughout the progression of diabetes mellitus remain underexplored. This structured narrative review evaluates transitional microbial dynamics from intact skin through to active ulceration and explores emerging microbiome-targeted therapies. Based on a structured literature search of PubMed, Scopus, and Web of Science, complemented by citation searching, and a narrative synthesis of 32 selected publications, current evidence suggests that diabetes-associated changes in the cutaneous microbiome involve heterogeneous alterations in microbial diversity and composition, which vary according to microbial community, anatomical location, and clinical status. DFS progression involves a profound ecological collapse, characterized by depletion of protective commensals (e.g., Staphylococcus epidermidis) and the predominance of virulent Staphylococcus aureus lineages alongside Gram-negative anaerobes. Consequently, precision interventions such as topical probiotics, synbiotics, and bacteriophage therapy have substantial potential to disrupt recalcitrant biofilms and reprogram host immunity toward pro-regenerative phenotypes. Ultimately, recognizing the skin as a primary target organ in diabetes mellitus highlights the need to shift DFS management toward a proactive framework. Validating these microbiome-modulating therapies through standardized clinical trials is crucial to restoring host-microbiota symbiosis and ultimately preventing lower-extremity amputations.
Related
- From Dysbiosis to Symbiosis: Using the Gut Microbiome to Improve Cancer Outcomes
- Oral versus vaginal Lactobacillus supplementation for endometrial dysbiosis: A paired pre and post–endometrial microbiome study
- Exploring gut microbiome dysbiosis in vasculitis in adults: a systematic review
- Functional gut microbiome dysbiosis is associated with overall survival after solid organ transplantation
- Editorial: Roles of metabolism, immunity, and microbiome in the pathophysiology of the breast cancer microenvironment
BibTeX
@article{julianrochina2026foot,
title = {{The Foot Skin Microbiome in Diabetes Mellitus: Transitional Dysbiosis, Ulceration, and Precision Microbiome-Based Therapeutics: A Narrative Review}},
author = {Iván Julián-Rochina and Mateo López-Moral and Esther García-Morales and Marta Izquierdo-Renau and José David Piñeiro-Ramos and José Luis Lázaro-Martínez},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218578},
url = {https://www.mdpi.com/2077-0383/15/21/8578},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Foot Skin Microbiome in Diabetes Mellitus: Transitional Dysbiosis, Ulceration, and Precision Microbiome-Based Therapeutics: A Narrative Review
AU - Iván Julián-Rochina
AU - Mateo López-Moral
AU - Esther García-Morales
AU - Marta Izquierdo-Renau
AU - José David Piñeiro-Ramos
AU - José Luis Lázaro-Martínez
PY - 2026
DA - 2026/11/03
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218578
UR - https://www.mdpi.com/2077-0383/15/21/8578
AB - Diabetic foot syndrome (DFS) is a severe complication affecting millions of people worldwide, yet its clinical management remains predominantly reactive, focusing on established ulcers rather than early preventive measures. Although the role of the cutaneous microbiome in chronic wounds is recognized, longitudinal ecological shifts in the skin of the foot throughout the progression of diabetes mellitus remain underexplored. This structured narrative review evaluates transitional microbial dynamics from intact skin through to active ulceration and explores emerging microbiome-targeted therapies. Based on a structured literature search of PubMed, Scopus, and Web of Science, complemented by citation searching, and a narrative synthesis of 32 selected publications, current evidence suggests that diabetes-associated changes in the cutaneous microbiome involve heterogeneous alterations in microbial diversity and composition, which vary according to microbial community, anatomical location, and clinical status. DFS progression involves a profound ecological collapse, characterized by depletion of protective commensals (e.g., Staphylococcus epidermidis) and the predominance of virulent Staphylococcus aureus lineages alongside Gram-negative anaerobes. Consequently, precision interventions such as topical probiotics, synbiotics, and bacteriophage therapy have substantial potential to disrupt recalcitrant biofilms and reprogram host immunity toward pro-regenerative phenotypes. Ultimately, recognizing the skin as a primary target organ in diabetes mellitus highlights the need to shift DFS management toward a proactive framework. Validating these microbiome-modulating therapies through standardized clinical trials is crucial to restoring host-microbiota symbiosis and ultimately preventing lower-extremity amputations.
SN - 2077-0383
ER -